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General NPI Number Information
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NPI Number | 1922526763
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Entity Type | Individual
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Provider Name | RYAN BIRTCHER PA
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Gender | Male
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 09/11/2018
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Provider Practice Location Address
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Address Line | 180 OTAY LAKES RD STE 203
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City | BONITA
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State | CA
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Zip | 91902-2444
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Country | US
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Telephone | 619-320-4775
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 609001
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City | SAN DIEGO
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State | CA
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Zip | 92160-9001
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Country | US
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Telephone | 619-528-4600
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Fax | 619-528-4625
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 55777
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License Number State | CA
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